How to Write a Health Care Fraud Investigation Report

A clear, well-written report is a reflection on the quality of the investigation you’ve conducted.

Posted by Dawn Lomer in Health & Safety, Healthcare Fraud, Medicare and Medicaid, SIU & OIG on July 11th, 2013

Health care fraud investigations can be among the most difficult cases an investigator can tackle. The laws and regulations related to health care fraud are more complicated, more technical and dynamic than in other types of fraud cases. And health care fraud cases often involve millions of dollars.

For this reason, a health care fraud investigation report must be flawlessly rendered, leaving no doubt about the process undertaken, the evidence gathered and the conclusions reached. Reports need to be well organized and well written to convey the facts accurately, clearly and without ambiguity.

Quantity Does Not Mean Quality

Sometimes health care fraud investigators are so concerned with including as much information as possible that they forget about the basic rules that make an investigation report readable, useful and conclusive. Grammar, punctuation and presentation lose out to volume of information and detail.

It’s understandable. With so many different laws and regulations to keep in mind, there’s a tendency to try to cover all bases and not leave out anything that might turn out to be significant.

However, a well written health care fraud investigation report focuses on both the information and the quality of the report. A well written report contains only the relevant information, reduces ambiguity, is focused, easy to read and reflects the overall quality of the investigation.

Organization

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To achieve these things, a report needs to be well organized. To create a well-organized report that gets the points across quickly and clearly:

  • Use subheads to organize information and makes it easier to follow.
  • Use lists for describing events or office procedures. Use bullets for most lists and use numbers if the order of events is important.
  • Avoid citing sources. The person you’re interviewing is the source of the information.
  • Use a report template to ensure reports are consistent and complete.

Interview Reports

Include the following information in interview notes:

  • Date, place, people present
  • Information identifying the interviewee: name, DOB, SSN, etc.
  • Interviewee contact information: address, phone numbers, work address

 Pay Attention to Grammar

Write in the third person: “He used a crowbar to break the lock on the back door.”

Write in the past tense, when an interview subject is recalling previous events. Use the present tense when talking about the interviewee’s current employer, current events, etc.

Use the active voice to avoid ambiguity. The passive voice often confuses the reader by concealing the identity of the person doing the actions.

Use short sentences. If you are using several commas or semicolons, consider splitting your sentence into shorter, simpler sentences.

Proofreading

Before you send a report, read the entire report, one section at a time, then read it again. Reading aloud can sometimes help you pick up mistakes that your eye skips over when reading silently.

Check for subject and verb agreement, correct use of punctuation and capitalization. Ensure only proper nouns are capitalized. Inconsistent and incorrect capitalization can be distracting to the reader.

Ask the following questions as you proofread:

  • Is the report free of my editorial comments or subjective conclusions?
  • If the interview subject provided third-party information, is the source of that information clear to the reader?

Once you are satisfied that your report is error-free, clear and accurate, send it off with confidence, knowing that it’s a reflection on the quality of the investigation you’ve conducted.

A good case management solution can make report writing quick and easy. Information in the case file can be collected into a comprehensive report with one click, and sent from anywhere with an internet connection.

 


Dawn Lomer
Dawn Lomer

Managing Editor

Dawn Lomer is the managing editor at i-Sight Software and a Certified Fraud Examiner (CFE). She writes about topics related to workplace investigations, ethics and compliance, data security and e-discovery, and hosts i-Sight webinars.